Matthew died at the age of 14 at the end of a stay in his grandparents’ country. The stay in a familiar environment gave many happy days. The days spent with his cousins and many friends. Then the illness, the aggravation and death.

It is now clear to everyone, haemorrhagic fevers caused by infection with one of the 4 types of the Dengue virus can kill even during an organised holiday trip. This virus, which is now widespread in most tropical and equatorial countries, is transmitted to humans by a type of mosquito, the Aedes, which is now widespread everywhere, even in Europe, and we are talking about the very common and widespread tiger mosquito.

from Messaggero Veneto of 30 July ’23

Matteo, a young Friulian boy of 14, had finished school and had flown with his mother to Brazil to spend a holiday, to meet his grandparents and aunt and uncle in the state of Parà, in Brazil. He had been living in the country since mid-June and was due to return to Italy at the end of July. During his stay, like many others, he had been bitten by those pesky mosquitoes, and at some point, for more than 10 days, he had begun to feel increasingly ill. First he was bedridden, at home, and then, his symptoms worsening, he was admitted to a hospital, where he was put under treatment. Within a few days, the situation rapidly deteriorated until his death on 29 July.

This dramatic event unfortunately confirms the dangerous nature of the disease and the need to pay great attention to insect bites, vectors (transporters) of the virus. Until now, controlling the territory and the presence of mosquitoes was the first and only prevention against the disease. We now have a preventive vaccine that works both in controlling the outbreak of the disease and also modulates the often dangerous secondary immune response in individuals who have already had the disease. The vaccine was approved by the US FDA, in December 22 by the European EMA, in February 23 by the AIFA in Italy.

To find out about the vaccine’s characteristics click here.
To find out where to get the Dengue vaccine in Italy click here.

AEDES

The dengue virus, transmitted through the bite of the Aedes mosquito, most of the time remains asymptomatic, without manifesting itself in any way. And this is what happens in most people, both locals and travellers. Sometimes it can manifest itself with increasingly aggressive symptoms and forms until, in rare cases, death occurs. Treatment is aimed at resolving the symptoms of this immune response and inflammation, which can be particularly violent. Sometimes the disease is characterised by the impairment and collapse of platelets in the blood, with the risk of severe haemorrhaging. In these cases, transfusions and control of probable shock states become essential.
In Latin America, the first half of 2023 was a period of exponential and uncontrolled growth of this disease. In all states, the presence and reproduction of Aedes and the consequent spread of the virus, from human to human through the bite of these insects, was surprisingly high.
Brazil has had the highest levels of spread of this disease for years, but Argentina, Peru and Colombia have also recorded a significant increase in cases and, unfortunately, an important increase in the mortality rate, particularly in the first months of the year. However, Dengue with the other diseases, such as Chickungunija and Zika, are present in all the other countries of Latin and Central America and in all the Caribbean islands.

The drama of Matteo and his family brings us back in a stark way to the need to inform oneself seriously and consciously before a trip. Not to underestimate indications and advice. To know the real risks and the ways to avoid them. Our organism is capable of overcoming anything, but let us help it strengthen itself.

QDENGA of TAKEDA

For the Dengue virus disease I would like to remind you again that there is now an effective and safe vaccine that is worth considering before travelling to endemic areas. FOR INFORMATION AND RESERVATIONS CLICK HERE.

VIRAL DENGUE FEVER: where it is found and what the risks are in individual countries (AFRICA)
Our review of dengue continues. Where is this increasingly talked about disease most prevalent and what is the risk in countries in Africa?

INTRODUCTION ON DENGUE DISTRIBUTION
At the end of the Covid-19 pandemic, the urge to travel in all of us has become unstoppable. Travelers are distributed everywhere in the world to discover new and unknown tourist destinations. It is necessary to understand the whereabouts of this disease, caused by a virus that, through the bite of a mosquito, has spread to most countries in the world. The incidence of dengue has increased dramatically in recent decades. Cases, reported to WHO, have risen from more than 600,000 in 2000 to more than 6 million in 2020. The vast majority of cases are asymptomatic or paucisymptomatic, that is, characterized by mild, self-managing symptoms. For this reason, the actual number of dengue cases is greatly underestimated and most cases are misdiagnosed as other febrile, flu-like illnesses.

HOW MANY DENGUE INFECTIONS AND CASES ARE THERE

One estimate based on epidemiological models puts dengue virus infections at more than 400 million per year. Of these, nearly 100 million manifest clinically; the remaining infections are without or with mild symptoms. Another recent study on dengue prevalence estimates that more than 3.9 billion people are at risk of virus infection, particularly in countries in the tropical belt.
The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. The Americas, Southeast Asia, and Western Pacific regions are the most affected, with Asia accounting for about 70 percent of the global burden of dengue virus disease.
A particularly aggressive form of Dengue Type 2 is emerging in some Latin American countries in early 2023, with an increase in deaths. Among them Argentina, Peru, and Brazil are the most represented.

For the past several years dengue has been spreading to new areas, including Europe. Local transmission was first reported in France and Croatia in 2010, and imported cases have been found in other European countries, particularly in the Mediterranean belt.
The number of dengue cases is steadily increasing. The U.S. region (South, Central and Caribbean) reported more than 3.5 million cases in 2019, of which more than 30,000 were classified as severe. A high number of cases were reported in Bangladesh (101,000), Malaysia (131,000), the Philippines (420,000), and Vietnam (320,000) in Asia in 2019.
In 2023, dengue viral fever is steadily increasing in almost all countries but widespread outbreaks are reported in Brazil, Colombia, Argentina, Peru, Cook Islands, Fiji, India, Kenya, Paraguay, Peru, Philippines, Reunion Islands, and Vietnam with exponential increases from 2021.
Today let us focus on countries on the African continent. Where do we find dengue fever in 2023 and with what risk assessment?
The following data are from the CDC and show the occurrence of dengue disease in different nations, with seasonal variations due to the presence of mosquitoes in the environment. This review of countries allows us to assess where most we can come in contact with the virus and what level of risk we find.

Today, in addition to a focus on the Aedes-type mosquito bite, prophylaxis is possible through
vaccination with the new QDENGA vaccine.The evaluation should always be done by asking for information from medical experts and specialists in the field.
To whom can it be administered?
Dengue vaccine is administered to all travelers who travel to areas at risk for business or tourism. Two doses are given starting at age 4 years and spaced 3 months apart. Booster should be given after 3 to 5 years, The vaccine is safe and effective So traveling to the countries listed below, especially those reported as (frequent/continuous) it is good to protect yourself from the disease by requesting vaccination.

Occurrence of DENGUE outbreaks and risk levels in African countries.

Country Level of risk
Angola Sporadic/Inconclusive
Benin Sporadic/Inconclusive
Burkina Faso Frequent/Continuous
Burundi Sporadic/Incontinuous
Cameroon Sporadic/Incertain
Cape Verde Sporadic/Incertain
Central African Republic Sporadic/Incertain
Chad Sporadic/Incertain
Comoros Sporadic/Incertain
Congo Sporadic/Incertain
Congo (Democratic Republic of) Sporadic/Inconclusive
Ivory Coast Sporadic/Incertain
Djibouti Frequent/Continuous
Egypt Sporadic/Incontinuous
Equatorial Guinea Sporadic/Incontinuous
Eritrea Frequent/Continuous
Ethiopia Frequent/Continuous
Gabon Sporadic/Inconstant
Gambia Sporadic/Incertain
Ghana Sporadic/Inconcert
Guinea Sporadic/Incontinuous
Guinea Bissau Sporadic/Incontinuous
Kenya Frequent/Continuous
Liberia Sporadic/Incertain
Madagascar Sporadic/Incertain
Malawi Sporadic/Incertain
Mali Sporadic/Incertain
Mauritius Sporadic/Incertain
Mayotte Sporadic/Incertain
Mozambique Sporadic/Incertain
Namibia Sporadic/Incertain
Niger Sporadic/Incertain
Mozambique Sporadic/Incertain
Namibia Sporadic/Incertain
Nigeria Sporadic/Incertain
Reunion Sporadic/Incertain
Rwanda Sporadic/Incertain
Sao Tome and Principe Sporadic/Incertain
Senegal Sporadic/Incertain

Seychelles Sporadic/Inconclusive
Sierra Leone Sporadic/Inconclusive
Somalia Frequent/Continuous
South Sudan Sporadic/Incontinuous
Sudan Frequent/Continuous
Uganda Sporadic/Incontinuous
United Republic of Tanzania Frequent/Continuous
Zambia Sporadic/Incontinuous
Zimbabwe Sporadic/Incontinuous

Update March 2023
Editorial Board Dr. Paolo Meo.
Dr. Paolo Meo is available to anyone who wishes to request information or book a consultation before leaving or returning from a trip or requesting dengue vaccination. One can email seg.cesmet@gmail.com or write a request message on WhatsApp at 3466000899